May is Melanoma and Skin Cancer Awareness Month
For my blog post this month I want to discuss something I’m really passionate about: skin cancer prevention. Many dermatology and aesthetics practices educate on and write about this topic because it is a prevalent issue we see in our line of work, even though it’s almost completely preventable. Unlike lung cancer from an addiction to smoking (for instance), you can still enjoy the sun safely while preventing skin cancer. While you may assume that I care about skin cancer from a purely aesthetic standpoint, the truth is that for me, it’s much more personal.
In 2016 a close family friend of ours growing up (who was like a second dad to me in many ways) was taken rather suddenly by metastatic Melanoma. What was particularly sad about his death was that he’d received clear margins from his melanoma removal and a clear PET scan, indicating that the disease had not metastasized (or spread) to any other areas internally. Following the surgical excision of the melanoma he was sent home with instructions to simply get annual skin checks. Then, after many years of these appointments, and occasional biopsies and in-office excisions that didn’t raise any major red flags, he began losing weight rapidly. He started to eat more than anyone could believe possible, yet the weight kept falling off of him. His PCP told him there was nothing to worry about, and like so many of us who take our practitioners’ advice as gospel, he didn’t pursue a second opinion. What they did not know then was that the melanoma had metastasized to his brain, and he died less than 6 months later.
While that is an incredibly sad and frightening story, my intention is not to cause fear, but rather, to educate. I feel strongly that we all ought to advocate for ourselves and our health when we suspect something might be “off”. My goal for this post is to inform you of what to look out for and how to properly protect yourself from ever dealing with such a preventable cancer as melanoma.
> First, let's discuss what causes melanoma.
Before you think, “The sun, duh!”, there’s actually a genetic component to melanoma as well as evidence to support that environmental factors can contribute to the development of melanoma.
According to the Mayo Clinic,
“It's likely that a combination of factors, including environmental and genetic factors, causes melanoma. Still, doctors believe exposure to ultraviolet (UV) radiation from the sun and from tanning lamps and beds is the leading cause of melanoma. UV light doesn't cause all melanomas, especially those that occur in places on your body that don't receive exposure to sunlight. This indicates that other factors may contribute to your risk of melanoma.”
One of the more memorable surgeries I was a part of at MUSC was the removal of a relatively small melanoma on the bottom of a man’s foot. Due to the need to take wide margins to ensure all of the cancer had been removed, the surgeon had to place tension sutures on the sole of this patient’s foot to prevent the incision from reopening, and the patient had to be on crutches for a few weeks to avoid pressure to the area. The gentleman had never been in a tanning bed and worked outside for most of his life in boots, yet because the melanoma presented on the sole of his foot only environmental and/or genetic factors could explain that location. It was eye-opening to say the least!
> Next, let's review how to spot most melanomas.
The majority of us have been taught the ABCDEs of melanoma, but to review it’s an acronym for:
> Now that we've reviewed the things you probably already knew, let's talk about the sneaky and surprising side of melanoma.
1. Most melanomas don’t start out as moles.
2. Melanoma can be colorless. I know, I know. Both of these points are confusing since I just educated you on how to spot a suspicious mole. But here’s what I want you to remember: Any spot that has changed, no matter the color, should warrant concern. Dermatologist Ashfaq Margoob states,
“Nearly 70% of skin melanomas do not develop in preexisting moles… [You need to] be aware of isolated pink spots, especially if the spot looks different than the other marks on the skin. Pay attention to any spot or mark that has an uneven texture, shape, border, or distribution of colors. In addition, any spot that has changed in some way should prompt a visit to your local doctor.”
3. In people of color, melanoma often looks different. It may present as a dark lesion or a darker patch of skin, and often shows up in odd places like the soles of feet or palms of the hand. Melanoma is rare in people with dark skin tones, but because it is often found at a later stage it can be particularly lethal. Keep a keen eye on your skin!
4. Melanoma can occur under the nail bed. If you see a dark line under your nail that’s purple or brown, get it checked out. This is called subungual melanoma and can mimic a bruised nail bed.
5. Yearly eye checks are vital even if you have great vision. Not only can eye exams pick up on diabetes mellitus and/or underlying hypertension, they also detect ocular melanoma. And because it can only sometimes be seen by the naked eye (a brown spot on the pigmented iris. And yes, pun intended!), special care needs to be taken. Yearly eye exams are a great way to get an idea of your overall health and to detect early ocular melanoma.
Interesting anecdote: I had an optometrist tell me one time that she had recently moved from the northeast and couldn’t believe how many cases of ocular melanoma she’d already seen. Thankfully it’s a rare form of melanoma, but no one is exactly sure if it’s caused by the patient’s environment (sun) or genetics. Her theory? The reflection of the sun off of the water acts as a sort of focused “laser-beam” of the sun’s rays, and more quickly damages the eyes. Wear your polarized sunnies, folks!
6. Mucosal melanoma is a thing. That’s a new one to me. It can be seen in the mouth, digestive tract, urinary tract and vagina. This lends itself to the genetics theory, but it confirms that recommended screenings are crucial for more reasons than we might be aware of.
7. Clusters of oddly shaped moles may mean you’re more likely to develop melanoma in your lifetime. Dysplastic Nevi Syndrome is the term for clusters of irregular moles, and are typically benign as long as they haven’t evolved; however, they do put you at 12 times the risk of developing melanoma in your lifetime.
I know that was a lot to digest, but as I said before my goal for this post is to give you the information you need to keep yourself and your loved ones protected.
If you haven't had the chance to read my blog on sunscreen, check out Summer Sun is Coming. It's a quick 4min read!
Lastly, and I cannot stress this enough, please keep and make your various screening appointments. Book your next dermatology appointment before you leave their office, call your optometrist now to schedule, and keep your recommended dental, colorectal and gynecological exams. No one particularly enjoys going to them, but they sure beat the alternative!
I hope you have a fun (and safe!) summer, and I hope I helped at least one person reading this. Please reach out to me at firstname.lastname@example.org if you have any questions!
Yours in skincare and sun protection,
Disclosure: Julia Miller is a Registered Nurse; however, this blog is not intended to substitute for legitimate medical guidance that should occur with your primary care provider or dermatologist when determining which products to use in conjunction with chronic medical conditions, or in conjunction with any long-term treatments. This blog is intended to be for information only.